Wait for hospital bed a life or death matter?

About 200 of the country's emergency-room doctors acknowledge that they know of patients who have died while waiting in ER hallways for an inpatient bed, according to a poll released Tuesday by the American College of Emergency Physicians during its annual meeting in Seattle.

It's a common practice called "boarding" patients, meaning they are left in the ER because there is no bed available for them in the hospital. Most of the 1,496 doctors who responded to the e-mail poll said they had grave concerns about it. Aside from patients who had died, half said they knew patients who had suffered because of the practice.

But "it's a myth" that uninsured patients cause such overcrowding, said Dr. Linda Lawrence, the group's president. Those patients are part of the crowd, she said Tuesday, but not the cause of the problem. All emergency patients, rich or poor, get parked in holding areas when hospitals can't accommodate them.

"It's the boarding that is crowding our emergency departments," Lawrence said. "This could be you — you might be the next person lying in that hallway with this little sheet just covering you and no privacy and dignity when you so want it most."

It's a problem that affects the local region as much as anywhere, local experts said.

"We all struggle with the issues of enough beds, enough staff, enough resources," said Chris Martin, administrative director of emergency services for Harborview Medical Center in Seattle. "There are times when we're down to two ICU [intensive-care unit] beds in the entire county."

One serious problem for the hospital is the lack of beds for patients who need inpatient mental-health care, she said. Between January and June, 1,155 people needed treatment in King County, according the King County Regional Support Network. Nearly a quarter of those spent an average of 72 hours being "boarded" before getting inpatient beds.

So, it's not really that the country's emergency departments are overcrowded, said Dr. Peter Viccellio of the State University of New York at Stony Brook's health sciences center. "It is the hospital which is overcrowded."

So what's needed? Hospitals should schedule discharges and elective surgeries so that more beds are available when ER admissions are typically high, Lawrence said.

That's not happening, she said, because "hospitals are paid more to take the elective surgical patients than our [emergency] patients."

Viccellio said hospitals should allow ERs to send some patients to inpatient units even when there are no beds. That would spread overloads more evenly throughout the hospital.

Other potential solutions, the emergency-medicine leaders said, include more psychiatric inpatient beds, more nursing staff and instructors, changes in insurance reimbursements and better access to specialty physicians.

"I don't think there's an easy solution to any of this," Martin said. "I think it's a really complex problem, and it's a symptom of our health-care system falling apart."